Vomiting Blood

Vomiting of blood in any amount is a serious symptom that should not be underestimated. It can accompany many serious diseases of the digestive tract. Because usually blood vomiting is caused by upper GI bleeding, blood may be also digested and causes tarry, black, foul smelling stool known as melena. Blood vomiting may be followed by blood expectoration after blood from digestive tract has been aspirated.


There are many causes of blood vomiting, I have selected only the most common and most important.

Cracks in the esophagus

Vomiting (especially after alcohol excess) can damage the lining of esophagus in the area where esophagus comes into stomach (gastroesophageal junction). A tear in mucosa causes bleeding that can be followed by vomiting of blood. This condition is called Mallory-Weiss syndrome. It may look quite dramatically, but it is not dangerous as the bleeding usually quickly stops by oneself.

Esophageal varices

Esophageal varices are dilated blood veins is the wall of esophagus that are filled with blood. Esophageal varices are typically found in liver cirrhosis and other conditions accompanied with portal hypertension. When blood can not flow well through liver tissue, it tries to use collateral veins. Unfortunately, some of these collateral veins are located in esophagus wall. They are unable to manage increased blood flow, dilate and protrude into esophageal lumen. Bigger esophageal varices have higher risk of bursting. A ruptured esophageal varix causes massive bleeding that manifests with both blood vomiting and melena. This is a medical emergency that must be acutely solved by a gastroenterologist.

Peptic ulcers

Stomach and duodenal ulcers can bleed slowly and manifest with presence of blood in stool. A sudden rupture of a stomach wall blood vessel caused by tumor growth may cause sudden episode of vomiting blood. Abdominal pain does not have to be present as it is more typical for peptic ulcer rupture.

Gastroesophageal reflux disease

This condition means return of acidic gastric juice back into esophagus where it can cause inflammatory changes of esophageal mucosa. This inflammation may be sometimes so strong that it creates large erosions and deep ulcers that can bleed and cause vomiting of blood.


Tumors of upper GI tract like esophageal cancer or stomach cancer ma cause bleeding when they damage a nearby located blood vessel. Bleeding is not often so massive to cause blood vomiting, it rather manifests as melena.

Blood clotting disorders

Any more serious blood clotting disorder may be associated with bleeding from mucous membranes of the digestive tract. These can be some rare congenital coagulation disorders such as hemophilia, but are much more these disorders are caused by anticoagulant drugs (such as widely used warfarin).

Diagnostic approach

It is necessary to determine the source of bleeding. Esophagogastroduodenoscopy (upper GI endoscopy) is the best diagnostic method that allows us to visualize the whole upper GI tract from esophagus to proximal duodenum. Gastroscopy is not only diagnostic method, but in the majority of cases it allows us to stop the bleeding. Signs of liver cirrhosis may be diagnosed by abdominal ultrasound and many blood clotting disorders may be diagnosed from blood tests. It is, of course, necessary to know patient’s current medication.


For conditions that are acutely life-threatening, it is necessary to stabilize the patient and prevent hemorrhagic shock occurrence. The bleeding must be stopped, usually by therapeutic esophagogastroduodenoscopy. When there is a sudden blood vomiting, we usually administer some proton pump inhibitors intravenously (helps against bleeding in peptic ulcer and reflux disease) and sometimes we use special haemostatic drugs. If we are unable to stop the bleeding by medication and endoscopically, it is usually necessary to stop it by surgical intervention.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources